title: Predictive factors for a good prognosis following surgery for temporal lobe epilepsy: a cohort study in Spain.
abstract: To investigate the outcome of temporal lobe epilepsy surgery and identify the variables which predict a good prognosis with respect to seizures in postoperative follow-up after two and four years. This retrospective study included 115 selected patients who underwent surgery for temporal lobe epilepsy between 1996 and 2007. In the second year after surgery 86.1% of patients had a good prognosis for seizure control (73.9% Engel class I and 12.2% Engel class II) and 89.2% (76.3% Engel class I and 12.9% Engel class II) in the fourth year. Sixty-four of 93 (68.8%) patients were free of disabling seizures (Engel class I) during the entire period and 78 (83.8%) had good prognosis (Engel class I and II). For the second year, logistic regression analysis revealed the following variables to be independently predictive of good seizure control: absence of two or more seizure episodes in the first year after surgery, normal postoperative video-EEG, and age at surgery of less than 35 years. In the fourth year, mesial temporal sclerosis, female sex and normal postoperative video-EEG were the predictive factors. For the group with a good prognosis in both the second and the fourth year, the predictive variables were: absence of two or more seizure episodes in the first year after surgery (OR: 13.762, CI 95%: 2.566-73.808, p<0.002) and normal postoperative video-EEG (OR: 16.301, CI 95%: 3.704-71.740, p<0.001). This study illustrates the sustained benefit of temporal lobe epilepsy surgery. The multivariate logistic regression analysis failed to identify a good predictive model composed of preoperative variables alone, although it was possible to build such a model with either pre- and postoperative variables or only postoperative variables.
authors.affiliation: Medical-Surgical Epilepsy Unit, Department of Neurology, Hospital de Cruces, Plaza de Cruces , Baracaldo, Spain. MISABEL.FORCADASBERDUSAN@osakidetza.net
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Forcadas-Berdusán
authors.forename: José Luis
authors.initials: JL
authors.lastname: Bustos-Sánchez
authors.forename: Elena
authors.initials: E
authors.lastname: Valle-Quevedo
authors.forename: Jon
authors.initials: J
authors.lastname: Aurrecoechea Obieta
authors.forename: Beatriz
authors.initials: B
authors.lastname: Mateos Goñi
authors.forename: Lorea
authors.initials: L
authors.lastname: Martinez-Indart
authors.forename: Ana
authors.initials: A
authors.lastname: Molano Salazar
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Gomez-Esteban
authors.forename: Iñigo
authors.initials: I
authors.lastname: Garamendi-Ruíz
mesh_terms: D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D015331:Cohort Studies; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D013030:Spain; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome